Provider Demographics
NPI:1326266024
Name:GOODMAN, MONA GAYLE (MSW)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:GAYLE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:3000 WESLAYAN ST
Mailing Address - Street 2:SUITE 347
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5700
Mailing Address - Country:US
Mailing Address - Phone:713-622-9002
Mailing Address - Fax:713-622-1940
Practice Address - Street 1:3000 WESLAYAN ST
Practice Address - Street 2:SUITE 347
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5700
Practice Address - Country:US
Practice Address - Phone:713-622-9002
Practice Address - Fax:713-622-1940
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00548LMedicare ID - Type Unspecified